Why are Medicare and Medicaid shown separately instead of combined?

They come from two different CMS data sources with no shared claim identifier, so they can't be reconciled into one number without double-counting or guessing. Every table and chart on this page keeps them fully separate.

Why is there no private/commercial revenue figure?

Private and commercial payer data comes from Transparency in Coverage files, which only publish negotiated rates — not claims or utilization volume. Without a volume figure, no revenue number can be computed for any provider from that data.

What does "Rank" mean in the Competitive Analysis & Benchmarks tables?

For a given CPT/HCPCS code, it's this provider's position by claims volume among all providers billing that same code at that geography level (State, National, or South Carolina for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to South Carolina only?

Medicaid is administered per-state with no single national fee schedule, so a state or national comparison the way Medicare has one isn't available. South Carolina (this provider's own state) is the only grouping that's conceptually meaningful.

Why are the numbers rounded to the nearest 10?

To avoid implying more precision than the underlying data supports at a single-provider level. Ratios are kept precise since they're a relative comparison, not a volume or dollar figure.

How current is this data?

The Medicare and Medicaid tables are both single current snapshots, not refreshed on a recurring schedule yet.

South Carolina Pediatrics Alliance, LLC (NPI 1184016941)

Key Findings

Field	Value
Entity Type	Organization
Organization	South Carolina Pediatrics Alliance, LLC
Address	601 Clemson Rd
City	Columbia
State	SC
ZIP	29229
Taxonomy	Pediatric Adolescent Medicine Physician
NPI Enumerated	March 3, 2015

Payer Source	Total Paid
Medicaid	$63.4M
Medicare	$0

This provider is effectively a Medicaid-focused pediatric practice: there is no Medicare billing on file and the practice reports $63.4M in lifetime Medicaid revenue, indicating Medicaid is the dominant — effectively sole — payer relationship reflected in these claims. The NPI was enumerated on 2015-03-03 (~11 years ago), establishing more than a decade of billed activity under this identity.

Revenue concentration is high: the precomputed top three Medicaid codes account for 57.0% of the provider’s total Medicaid revenue, signifying that a small set of ambulatory evaluation-and-management and preventive codes drive most of the financial throughput. Those leading codes are 99213 ($16.2M revenue, 246K claims, $66 avg paid/claim — 26.1% of Medicaid revenue), 99214 ($13.4M revenue, 139.8K claims, $96 avg paid/claim — 21.6% of Medicaid revenue), and 99392 ($5.8M revenue, 59.5K claims, $98 avg paid/claim — 9.4% of Medicaid revenue).

The code mix indicates a high-volume pediatric primary-care and preventive-care operation: large revenues and claims for 99213 and 99214 (established patient E/M) together with strong volumes in well-child/preventive codes 99392, 99391, 99393, and 99394 point to routine longitudinal care and scheduled well visits as the core service line. Heavy activity in vaccine administration codes 90460 and 90461 (161.5K and 71.1K claims respectively) further supports a clinic model delivering mass immunizations as part of routine pediatric care.

Competitive standing in-state is dominant for many pediatric services: 99213 ranks #2 of 2766 providers in-state (100th percentile; extreme outlier), 99214 ranks #5 of 2483 (100th percentile; extreme outlier), and 99392 ranks #2 of 377 (100th percentile; extreme outlier). Multiple other codes — including 90460, 99393, 99394, 90461, 96127, 96110, and 96161 — are at the 100th percentile or near it and often rank #1 or #2 in-state, indicating the practice is a major pediatric volume center compared with peers.

The practice also operates significant point-of-care and lab testing alongside preventive care: high-volume respiratory and infectious-disease testing codes such as 87635 ($1.6M revenue, ranks #2 of 174, 99th percentile), 87502 ($1.5M revenue, ranks #2 of 105, 99th percentile), and 87426 ($762.5K revenue, ranks #6 of 236, 98th percentile) show substantial diagnostic testing throughput, suggesting integrated testing workflows for acute respiratory illness. Additionally, oral fluoride application (99188) and behavioral/developmental screening codes (96127 and 96110) appear at extreme outlier volumes, implying the clinic embeds preventive oral health and standardized developmental/behavioral screening into routine visits.

Operational implications: the payer-and-code mix points to a high-throughput ambulatory pediatric office or clinic network that bills heavily for established-patient E/M and well-child visits, conducts mass vaccination encounters, and pairs those visits with screening instruments and rapid diagnostic testing. The high counts for low-unit-value codes (e.g., 96127, 96110, 90461) and very large claim volumes (e.g., 246K claims for 99213; 161.5K for 90460) are consistent with a high-volume, standardized visit model where many patients receive bundled preventive services in single encounters.

Risk and reliance considerations for payers: given that 57.0% of Medicaid revenue is concentrated in three ambulatory/preventive codes and the practice shows extreme outlier volumes across many pediatric-related codes, payers should treat this provider as a high-impact network participant for pediatric Medicaid populations in the state. Contracting, utilization management, or program outreach efforts aimed at pediatric preventive care, immunization campaigns, or respiratory testing will likely have outsized impact if targeted at this provider.

Medicaid: Complete Services Breakdown

Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.

102 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	246,050	$70	$16.2M
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	139,770	$100	$13.4M
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	59,510	$100	$5.8M
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	55,410	$90	$5.1M
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	161,520	$30	$5M
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	36,010	$100	$3.5M
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	15,410	$110	$1.6M
87635	Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus…	31,870	$50	$1.6M
87502	The lab analyst performs a test to determine the presence of multiple types or subtypes of influenza virus through nucleic acid detection using multiplex amplified probe technique and possibly…	18,640	$80	$1.5M
G9153	Mapcp demonstration - physician incentive pool	26,120	$50	$1.3M

Showing 1–10 of 102

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other South Carolina providers billing the same CPT/HCPCS codes.

Claims Volume vs. South Carolina Distribution

South Carolina Pediatrics Alliance, LLC — 23 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — South Carolina

Full comparison — all codes billed, vs. South Carolina median

102 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
90834	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	139	210	320	$130	$707.4K
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	2	280	600	$90	$299K
90847	A provider meets with the patient’s family with the patient present to counsel the family on the psychological issues affecting the patient and the family. The provider supplies psychotherapy to the…	52	240	260	$160	$257.9K
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	2	2,770	210	$60	$254.5K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	526	710	350	$60	$247.2K
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	5	2,480	350	$80	$246K
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	2	380	160	$100	$226.8K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	1	390	100	$100	$148.3K
87502	The lab analyst performs a test to determine the presence of multiple types or subtypes of influenza virus through nucleic acid detection using multiplex amplified probe technique and possibly…	2	110	130	$70	$134.7K
U0002	2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc	10	50	340	$80	$129.4K

Showing 1–10 of 102

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Kraemer Womens Care, LLC	SC	Obstetrics & Gynecology Physician	$0	$12.4M
Firm Foundations Counseling & Wellness	SC	Professional Counselor	$0	$3.6M
Suneetha Morthala	SC	Rheumatology Physician	$1.1M	$0
Lexington Health Inc	SC	Radiology Clinic/Center	$414.9K	$13.1K
William Johnson	SC	Ophthalmology Physician	$303.2K	$0
Lexington Health Inc	SC	Ambulatory Surgical Clinic/Center	$230.8K	$0
Carlton Cauthen	SC	Pulmonary Disease Physician	$212.8K	$0
Jessica Hall	SC	Medical Physician Assistant	$105.2K	$0
Amanda Warner	SC	Foot Surgery Podiatrist	$83.5K	$0
Kimberly Mouzon	SC	Acute Care Nurse Practitioner	$74.7K	$0

South Carolina Pediatrics Alliance, LLC — Billing Profile & Reimbursement Data

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South Carolina Pediatrics Alliance, LLC — Billing Profile & Reimbursement Data

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Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References